Clinical Factors Associated With Prescription Drug Use Disorder in Urban Primary Care Patients with Chronic Pain

Abstract

This study examined characteristics associated with prescription drug use disorder (PDUD) in primary care patients with chronic pain from a cross-sectional survey conducted at an urban academically-affiliated safety-net hospital. Participants were 18-60 years old, had pain for ≥ 3 months, took prescription or non-prescription analgesics, and spoke English. Measurements included the Composite International Diagnostic Interview (PDUD, other substance use disorders (SUD), Post-traumatic Stress Disorder (PTSD)); Graded Chronic Pain Scale, smoking status; family history of SUD; and time spent in jail. Of 597 patients (41% male, 61% black, mean age 46 years), 110 (18.4%) had PDUD of whom 99 (90%) had another SUD. In adjusted analyses, those with PDUD were more likely than those without any current or past SUD to report jail time (OR 5.1, 95% CI 2.8-9.3), family history of SUD (OR 3.4, 1.9-6.0), greater pain-related limitations (OR 3.8,1.2-11.7), cigarette smoking (OR 3.6, 2.0-6.2), or to be white (OR 3.2, 1.7-6.0), male (OR 1.9, 1.1-3.5) or have PTSD (OR 1.9, 1.1-3.4). PDUD appears increased among those with easily identifiable characteristics. The challenge is to determine who among those with risk factors can avoid, with proper management, developing the increasingly common diagnosis of PDUD.For reprints and correspondence: Jane Liebschutz MD MPH, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Ave, 2 nd Floor, Boston, MA 02118-2334, jane.liebschutz@bmc.org. PERSPECTIVE This article examines risk factors for prescription drug use disorder (PDUD) among a sample of primary care patients with chronic pain at an urban, academic, safety-net hospital. The findings may help clinicians identify those most at risk for developing PDUD when developing appropriate treatment plans.

Defining Racial and Ethnic Disparities in Pain Management

“…For example, despite accumulating evidence that African Americans who suffer from acute or chronic pain are not at increased risk of opioid abuse or diversion [7,34,56], opioid underprescribing to such individuals continues to be common.…”

Prescription pain reliever misuse prevalence, correlates, and origin of possession throughout the life course

“…While individuals younger in age (Papaleontiou, Henderson, Turner, et al, 2010) are most likely to be at risk for pain reliever misuse, population prevalence estimates have shown that men (Boscarino, Rukstalis, Hoffman, et al, 2010), and individuals who identify as White/nonHispanic (Liebschutz, Saitz, Weiss, et al, 2010) have an increased risk for misuse. However, these findings may often overlook how risk factors for pain reliever misuse change with age.…”

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

“…19 We found that smokers had over twice the odds of an illicit drug result. Little previous research has examined associations between smoking and chronic pain patient UDT results, although smoking is associated with opioid misuse/abuse among chronic pain patients 32,33 and with illicit drug abuse in the general population. 44 Our hypothesis that males would have more illicit drug results was not confirmed; findings in previous studies were mixed.…”